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Study Overview

Nudges for Rural Sanitation: Evaluating low-touch methods to promote latrine use in Rural Bihar
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Despite a rapid increase in toilet construction in the last five years, India continues to have one of the world’s highest open defecation rates, even among latrine owners. For example, 23% of latrine owners across four of India’s largest states report practising open defecation (Gupta et al., 2019). Our formative research in rural Bihar – an area with high levels of persistent open defecation (Gupta et al., 2019) – helps explain why. Latrine owners face three persistent behavioural barriers to exclusive latrine use: anxiety around pit-emptying causes latrines to be viewed as a limited resource, gender norms lead latrines to be perceived as primarily for women’s use, and the experience of using latrines is perceived as being less enjoyable than open defecation. In this paper, we use a Randomised Controlled Trial (RCT) to evaluate the potential of nudges to help mitigate these behavioural barriers and thereby contribute to ending the practice of open defecation in rural India.
Water and Sanitation
Additional Keywords:
Open Defecation, Behaviour Change, Behavior Change, Nudges, Swachh Bharat, Rural Sanitation, Latrine, Latrine use, Bihar
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Principal Investigator(s)

Name of First PI:
Pulkit Agarwal
Name of Second PI:
Karan Nagpal

Study Sponsor

Bill and Melinda Gates Foundation
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Intervention Overview

We employ a behavioral science approach to design and evaluate a number of low-touch, cost-effective behavioural nudges that we implement in household latrines and that target each of the three behavioural barriers that we have identified. To address the pit-emptying barrier, we create an informational poster tailored for different types of latrines that shows how individuals can empty their pits, reframes pit-emptying as an acceptable activity, and provides a predicted date of pit-emptying customised for each household. To address the gender barrier, we create a poster that frames latrines as a resource shared by family members of all genders, as well as a toilet-use schedule to help households coordinate latrine use. To address the experience barrier, we provide all latrines with a fresh coat of paint, a “toilet kit” containing essential supplies for latrine upkeep, and a radio installed in the latrine to make latrine use enjoyable and recreate the social conditions households cited as key positive aspects of practicing open defecation.
Theory of Change:
Please check the attached pre-analysis plan document.
Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
FINISH Society
Type of Organization:
NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:
Bill and Melinda Gates Foundation
Type of Organization:
NGO (International)

Intervention Timing

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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
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Method Details

Details of Evaluation Approach:
We are currently conducting a household-level Randomized Controlled Trial (RCT) in Darbhanga District, Bihar, to rigorously measure the effect of our interventions on the salience of behavioural barriers and reported open defecation rates. Our study design uses a number of important innovations in data collection to generate high-quality data on defecation practices. These methods include permissive framing to overcome social desirability bias, visual likert-style questions that capture the salience of different behavioural barriers, and the use of door-clickers as an alternative data collection methodology for assessing the frequency of latrine use. Additionally, we ask a series of three questions on defecation practices that allows respondents to report both using latrines as well as open defecating in three time periods: yesterday, the past week in the morning, and the past week at other times of the day. By May, our study will have generated results on whether low-touch nudges are a cost-effective way of reducing open-defecation and diminishing the salience of some of the most critical behavioural barriers restricting latrine use in rural Bihar.
Outcomes (Endpoints):
Our primary outcome variables: 1. Open defecation: We will collect the following three indicators for the main respondent: a. Whether the respondent practiced open defecation and/or used a latrine at all in the previous day. b. Whether the respondent practiced open defecation and/or used a latrine at all in the morning during the past week. c. Whether the respondent practiced open defecation and/or used a latrine at all at other times of day besides the morning. 2. Salience of behavioural barriers that restrict latrine usage Our second outcome variables are latrine-oriented behaviours (See attached PAP for detailed information).
Unit of Analysis:
The primary hypothesis questions are: 1. What is the effect of the intervention on rates of open defecation reported by those who are offered the intervention, compared to those who are not offered the intervention? 2. What is the effect of the nudge intervention on the salience of the three behavioural barriers to latrine use that we have identified as especially salient? These three behavioural barriers are: pit-emptying, gender-norm barriers to latrine use; associations of hassle and unpleasantness with latrine use. The secondary hypothesis questions are: 1. Does treatment affect other latrine-oriented behaviours and perceptions? These include: number of times latrine(s) is/are cleaned per week, self-reported cleanliness of latrine(s) 2. How do treatment effects on all outcomes of interest (OD rates, latrine use rates, barrier salience scores) vary by individual and household characteristics? These include: gender, age, baseline OD rates, religion, caste, education levels, socioeconomic Status (as measured by the Poverty Probability Index (PPI))
Unit of Intervention or Assignment:
Number of Clusters in Sample:
Number of Individuals in Sample:
1,872 household-latrines
Size of Treatment, Control, or Comparison Subsamples:
804 treatment, 1064 control

Supplementary Files

Analysis Plan:
IDinsight-Nudges for Rural Sanitation Impact Evaluation Design Document.pdf
Other Documents:

Outcomes Data

We are conducting a household survey (at baseline and endline) to collect this data.
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Treatment Assignment Data

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Data Analysis

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Study Materials

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Registration Category

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Prospective, Category 1: Data for measuring impacts have not been collected

Completion Overview

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Preliminary Report:
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Data Availability

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Study Stopped